腹腔镜经括约肌间切除术联合结肠成形术治疗超低位直肠癌的疗效与安全性研究

Effectiveness and safety of laparoscopic intersphincteric resection combined with coloplasty for ultra-low rectal cancer

目的探讨腹腔镜经括约肌间切除术(ISR)联合结肠成形术治疗超低位直肠癌的疗效与安全性。方法选取2019年5月至2021年7月中国人民解放军火箭军特色医学中心接受ISR联合结肠成形术治疗的21例超低位直肠癌患者作为研究对象,定义为观察组。另将按1:2配对同期接受ISR治疗的42例超低位直肠癌患者作为对照组。观察记录两组手术相关指标(手术时间、术中出血量、住院时间)及术后并发症情况(吻合口狭窄、吻合口漏、肺部感染、尿潴留),测量术后肛管直肠压力【直肠静息压(RRP),肛管静息压(ARP),肛管最大收缩压(AMSP),直肠初始感觉阈值(FRS),直肠最大耐受容积(RMTV)】,评估术后肛门功能【LARS评分、Wexner失禁评分(WIS)、VAS评分】。结果观察组手术时间长于对照组(P<0.05);两组术中出血量、住院时间比较差异均无统计学意义(均P>0.05)。回肠造口还纳术后3个月、6个月、12个月,观察组LARS评分、WIS评分均低于对照组,VAS评分均高于对照组(均P<0.05)。回肠造口还纳术后3个月,观察组RRP小于对照组(P<0.05),观察组ARP、AMSP、RMTV大于对照组(均P<0.05),两组FRS比较差异无统计学意义(P>0.05)。观察组1例出现吻合口漏,1例出现吻合口狭窄,0例出现肺部感染,1例出现尿潴留;对照组2例出现吻合口漏,2例出现吻合口狭窄,1例出现肺部感染,2例出现尿潴留。两组并发症总发生率分别为14.3%和16.7%,比较差异无统计学意义(P>0.05)。结论结肠成形术是一种安全有效的结肠重建手术,腹腔镜ISR联合结肠成形术治疗超低位直肠癌安全有效,可有效改善患者术后肛门功能,具有较好的临床应用前景。

Objectives To determine the effectiveness and safety of laparoscopic intersphincteric resection(ISR)combined with coloplasty for ultra-low rectal cancer.Methods Twenty-one patients with ultra-low rectal cancer treated with ISR combined with coloplasty between May 2019 and July 2021 at the PLA Rocket Force Medical Center were selected as the treatment group.These patients were matched in a 1:2 ratio to 42 patients with ultra-low rectal cancer treated with ISR alone in the same period.The followings were compared between the two groups:surgical details(duration of surgery,intraoperative blood loss,and duration of hospitalization),postoperative complications(anastomotic stenosis,anastomotic leakage,lung infection,urinary retention),anorectal manometry measurements[rectal resting pressure(RRP),anal resting pressure(ARP),anal maximum squeeze pressure(AMSP),first rectal sensation(FRS),rectal maximum tolerance volume(RMTV)],and evaluated postoperative anal func⁃tion[LARS score,Wexner incontinence score(WIS),VAS score].Results Duration of surgery was significantly longer in the treatment group than in the control group(P<0.05),while the two groups did not differ significantly in intraoperative blood loss and duration of hospitalization(P>0.05).At 3,6,and 12 months after ileostomy reversal,LARS score and WIS score were signifi⁃cantly lower,while the VAS score was significantly higher in the treatment group than in the control group(P<0.05).At 3 months after ileostomy reversal,RRP was significantly lower,while ARP,AMSP,and RMTV were significantly greater in the treatment group than in the control group(P<0.05);FRS did not differ between the two groups(P>0.05).In the treatment group,one patient had anastomotic leakage,one anastomotic stenosis,no lung infection,and one urinary retention.In the control group,two patients had anastomotic leakage,two anastomotic stenoses,one lung infection,and two urinary retention.The overall compli⁃cation rate was 14.3%in the treatment group and 16.7%in the control group,with no significant differences between the two groups(P>0.05).Conclusion Coloplasty is a safe and effective colon reconstruction surgery.Laparoscopic ISR combined with coloplasty is a safe and effective treatment for ultra-low rectal cancer.It can improve patients’postoperative anal function and has great potential for broader clinical application.